Résumé
Guide wire plays an important role in the fixation of femoral neck fracture with dynamic hip screw (DHS). Breakage of a guide wire during operation is a very rare condition. We met such a dilemma in DHS fixation of a 54-year-old male patient who sustained Garden type IV fracture of the right femoral neck. The distal end of the guide wire broke and was entrapped in the fractured femoral neck. We tried to get the broken part out by a cannulated drill. Reaming was started with the cannulated drill slowly rotating around the guide K-wire until the reamer fully contained the target under fluoroscope. A bone curette was used to get the broken wire out but failed, so we had to use the cannuated drill to dredge this bone tunnel. Finally the broken wire end was taken out, mixed with blood and bone fragments. Through the existing drilling channel, DHS fixation was easily finished. The patient had an uneventful recovery without avascular necrosis of femoral head or non-union of the fracture at one year's follow-up. A few methods can be adopted to deal with the broken guide wire. The way used in our case is less invasive but technically challenging. When the guide wire is properly positioned, this method is very practical and useful.
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Humains , Mâle , Adulte d'âge moyen , Fils métalliques , Ablation de dispositif , Fractures du col fémoral , Imagerie diagnostique , Chirurgie générale , Ostéosynthèse interne , Méthodes , RadiographieRésumé
Objective To investigate the association of post-stroke depression (PSD) with gene polymorphisms of catechol-O-methyl transferase (COMT) Val1 08/158Met and dopamine transporter 40bp variable number of tandem repeats (VNTR) in dopamine metabolism system. Methods Sixty-eight patients with PSD and 91 patients only suffered from stroke, admitted to our hospital from January 2010to June 2010, were chosen; the gene polymorphisms ofCOMT Val108/158Met and DAT 40 bp VNTR were analyzed by using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Results The genotypes of COMT gene amplifications were wild type (G/G),homozygous mutant type (A/A) and heterozygous type (A/G); 7 repeated genotypes (7/7, 9/7, 10/7, 10/9,10/10, 11/10 and 11/11) were noted in the DA T gene amplifications; frequencies of COMT alleles and genotypes were significantly different between the 2 groups (x2=5.703, P=0.017;x2=6.489, P=0.039). The frequencies of COMT alleles and genotypes were significantly different between the 2 female groups (x2=4.610, P=0.032;x2=6.547, P=0.024), but no significant differences were found between the 2 male groups (P>0.05). The frequencies and heterozygosity of DAT alleles and genotypes showed no obvious differences between the 2 groups (P>0.05). Conclusion The gene polymorphism of COMT Val108/158Met may be associated with PSD, while that of DAT 40bp VNTR is not.
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Objective To explore the relationship between polymorphism of 5-hydroxy tryptamine 2A(5-HT2A)receptor T102C gene and post-stroke depression(PSD),and investigate the heredity-related pathogenesis of PSD.Methods The polymerase chain reaction and restriction fragment length polymorphism(PCR-RFLP)method was applied to test the allele frequencies and genotype of 5-HT2A receptor T102C gene in 97 patients with PSD and 72 patients without depression after stroke.Results The frequency of mutant C allele in patients with PSD was significantly lower than that in patients without depression(P<0.05),and the frequency of homozygote C/C genotype in patients with PSD was also obviously lower than that in patients without depression(P<0.05).Conclusion The 5-HT2A receptor T102C gene may be the susceptibility gene of PSD and C allele may be the protective factor of subjects suffering from PSD.
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<p><b>OBJECTIVE</b>To observe the effects on the lower limbs function after lumbar or sacral nerve root transferring to reconstruct urination function.</p><p><b>METHODS</b>Nine patients with bladder dysfunction and normal lower limb function after spinal cord injury were treated with anastomosis the S2 or S3 nerve root with the normal lumbar or sacral nerve root to reconstruct a new bladder artificial reflex arc. Then the alterations on the sensation and motor function of the lower limb after the surgery were observed.</p><p><b>RESULTS</b>Myodynamia of the legs decreased slightly, and the decreasing about half grade of the myodynamia in the plantar flexion of the ankles were detected in 4 of 9 patients with S1 transferring. And the myodynamia recovered 3 months postoperatively. No obvious decreasing of the myodynamia appeared in the other cases.</p><p><b>CONCLUSION</b>No obvious effects on the motor function can be found after the single lumbar or sacral nerve root transferring to reconstruct urination function.</p>
Sujets)
Adulte , Femelle , Humains , Mâle , Adulte d'âge moyen , Exercice physique , Études de suivi , Membre inférieur , Région lombosacrale , Réflexe , Rhizotomie , Traumatismes de la moelle épinière , Racines des nerfs spinaux , Chirurgie générale , Résultat thérapeutique , Vessie urinaire , Vessie neurologique , Chirurgie généraleRésumé
<p><b>OBJECTIVE</b>To investigate the psychological stress in the survivors of the May 12, 2008 Wenchuan earthquake transferred to Guangzhou for treatment, and explore the association between the psychological stress and the physical injuries related to the earthquake to promote both the physical and psychological recoveries of the survivors.</p><p><b>METHODS</b>Fifty-five earthquake survivors, including 27 with 28 without physical injuries, were transferred in our hospital 1 week after the earthquake. The Posttraumatic Stress Disorder (PTSD) Checklist-Civilian version (PCL-C) and the Self Reporting Questionnaire (SRQ) were used to investigate the psychological stress in these survivors.</p><p><b>RESULTS</b>The earthquake caused serious psychological stress in these survivors, and 43.63% of the survivors had high PCL-C scores (50 or above) and 78.18% had high SRQ scores (over 7), with 41.82% having high scores for both PCL-C and SRQ. The survivors with physical injuries generally had high PCL-C and SRQ scores (49.780-/+14.503 and 12.110-/+4.619, respectively), which, however, were not statistically different from the scores of the survivors without injuries (44.460-/+13.206 and 10.460-/+5.000, respectively, P>0.05). The injured survivors showed high scores for the subscales of persistent avoidance symptoms and of anger and irritability, in which the item scores for "efforts to avoid activities or places that arouse recollections of the earthquake" and "feeling of detachment or estrangement from others" were significantly different between the survivor with physical injuries and those without (P=0.034 and 0.018, respectively).</p><p><b>CONCLUSION</b>The Wenchuan earthquake causes serious psychological stress in the survivors, and the wounded are more inclined to have persistent avoidance symptoms and enhanced irritability. In addition to the care of the physical injuries, psychological counseling and social support may help ameliorate the psychological trauma in the survivors and reduce the incidence of PTSD.</p>
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Adolescent , Adulte , Sujet âgé , Femelle , Humains , Mâle , Adulte d'âge moyen , Jeune adulte , Chine , Tremblements de terre , Stress psychologique , Psychologie , Enquêtes et questionnaires , Survivants , Psychologie , Plaies et blessures , PsychologieRésumé
Objective To evaluate the injuries in Jiangyou Field Hospital first week after Wenchuan earthquake,and accumulate experience for better medical services and better-built field hospitals to meet the demands of the earthquake-stricken areas.Methods Classification was performed in 1 905 patients with emergency treatment.The medical records of those with hospital stay were retrospectively analysed,including geographical distribution,trauma type,diagnosis,initial treatment and outcomes.Results Six hundred and twenty-nine(33%)patients were hospitalized,with an average of 2 to 100 years old(median,41.2).Three hundred and eighty-four patients(61%)were admitted within the first three days after earthquake.The patients were mainly from Jiangyou City(245,39%),Beichuan County(194,31%)and Pingwu County (158,25%).The most common types of injuries were superficial lacerations(326,51.8%),fractures(202,32.1%) and soft tissue contusions/sprains(87,13.9%),among whom 15 experienced severe squeeze.There were 318 injuries to pelvis and extremities(50.6%),117 to head(18.6%)and 43 to back(6.8%),and 73 cases had multiple injuries (11.6%).Of 376 patients(59.8%)with operation,326 received debridement,21 external fixation,19 internal fixation, 11 amputation,4 laparotomy,4 fasciotomy and 2 craniotomy.The incidence of postoperative infections was 11.8%.Death occurred in 39 patients due to cerebral trauma,pelvic fracture,abdominal hemorrhage and multiple injuries.Conclusion When the earthquake has destroyed the major medical facilities,rapid organization of medical rescue teams,making full use of remaining medical resources and recovering electricity play an important role in the rescue of victims and reduction of mortality.Orthopaedic surgeons must dominate the medical teams as most of the earthquake victims suffer from injuries to the extremities.
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<p><b>OBJECTIVE</b>To evaluate the results of a self-designed bladder controller for restoring micturition function in paraplegic dogs.</p><p><b>METHODS</b>The spinal cords of 4 dogs were transected above the cone. Electrodes were implanted in S2 bilaterally and connected to the subcutaneous receivers for external activation. Microsurgical technique was employed to perform dorsal rhizotomy of S1-3 intradurally. The dogs were stimulated daily to observe micturition. Urodynamic testing and vesicography were performed.</p><p><b>RESULTS</b>All the dogs acquired micturition under the control of electric stimulation, with urine volume 80-140 ml per time. The mode of micturition was post-stimulus voiding. Vesicography revealed that the bladder was filled well and the bladder neck was open in the micturition course of electric stimulation. Residual urine volume was 15-20 ml. Urodynamic testing found that the bladder pressure and intraurethral pressure increased simultaneously, but when the intraurethral pressure was greater than the bladder pressure, no micturition occurred. The pressure decreased to baseline rapidly and the bladder pressure decreased slowly between two bursts. Micturition occurred when the bladder pressure was greater than the intraurethral pressure.</p><p><b>CONCLUSIONS</b>The self-designed bladder controller together with a sacral deafferentation procedure can restore micturition function of paraplegic dogs.</p>